Republicans have made clear that dismantling Medicare is a top priority of their 2012 legislative agenda. Just this week, Rep. Paul Ryan said Republicans should “absolutely” stick with his Medicare plan, adding, “Not one member thinks we should backtrack.”

Over the past year, Republican efforts to force seniors to pay more than double what they would pay under traditional Medicare – by converting Medicare into a voucher-type program – were repeatedly rejected by the American people and rejected by Congressional Democrats. Recently, however, vocal opposition to the extreme Republican ideology comes from a long-time advocate of the Republican-backed health policy proposals.

Henry Aaron, considered one of the “fathers” of the premium support model, and health economist Austin Frakt, argued that Republican attempts to embrace his concept, “lack safeguards for beneficiaries. They threaten to shift costs to the elderly and disabled and force them to shop for coverage in a confusing insurance market.”

In their essay in last week’s New England Journal of Medicine, Aaron and Frakt unequivocally rejected the Republican proposals as dangerous policy. In contrast to Aaron’s original premium support concept developed in 1995, the two authors ask two fundamental questions of the Republican proposals: “Is premium support along the lines now being proposed a good idea? Is now the time to be making fundamental changes in Medicare? We believe that the answer to both questions is no.” They continue, “Whatever virtues such a [premium support] plan may have had in 1995, circumstances have changed.”

Instead, Aaron and Frakt argue that “traditional Medicare is better structured than private plans to meet that [growth] target without harming enrollees.” They conclude that implementation of the Affordable Care Act is the most important step to strengthen Medicare and control future growth in expenditures. We agree.